In S. King County, an extraordinary effort to bring better health

Originally published April 25, 2014 at 12:03 pm

Updated April 28, 2014 at 6:31 pm

Burmese refugee Thian Mawy, 19, with her baby, Peter, at their Tukwila apartment, sometimes struggles with transportation to medical appointments. For many low-income families like Mawy’s, lack of transportation keeps them from getting health care. Global to Local, a coalition of groups working on health issues in South King County, has tried to help by organizing carpools and bus vouchers.

Rosario Santiago, in red, lends a hand pushing twins during a Global to Local walking group at Foster High School. Davalos, at center in rear, says she loves helping families become healthier through exercise and good food.

Alma, originally from Mexico, struggles with weight and high blood pressure. But she’s found help at New Hope Health Center, a partner with Global to Local, and has helped connect other immigrants in her apartment complex to the center and its services.

Tony Tansey snuggles with his 3-year-old daughter, Kylie, on the basement floor of Tukwila’s Riverton Park United Methodist Church. The single dad, a cabinetmaker, has lived at the church for about a year, trying to get ahead on bills. Homelessness, as well as lack of access to good food and health services, are some of the challenges facing low-income families in Tukwila, says the Rev. Jan Bolerjack, pastor at Riverton Park. The church has hosted some of Global to Local’s Community Conversations and programs.

Tony Tansey works at putting his daughter, Kylie, to bed in the basement of the Riverton Park United Methodist Church, where he has lived for about a year, trying to get ahead on bills. Despite having steady work, he says, “I’m just really stuck.”

Children play outside an apartment complex in Tukwila, where safe places to play are not always accessible for folks without transportation.

Dannia Garcia, of Burien, feeds her daughter, Valerie, during a Global to Local cooking class for the Latino community in SeaTac. Global to Local also provides diabetes and nutrition education, as well as culturally tailored exercise classes.

Dentist Dr. John A. Johnson works with patients inside the Medical Teams International dental van outside of New Hope Health Center in Tukwila. The health center, based at Fellowship Bible Church, provides free primary medical care and counseling services. Pastor David Sobocinski, executive director of New Hope, says Global to Local has provided a framework for many local organizations to share information and refer people to services such as the dental van.

It’s a scene that every mother knows all too well: Monica Davalos tells her daughter, Arlette Ramirez, she’ll have to wait for a healthy snack instead of grabbing a sugary treat at the grocery store. Her son, Abraham, gets a laugh out of it all while her father, Ernesto Davalos, stays out of it. Ernesto’s diabetes diagnosis in January helped the family start to understand the importance of nutrition and exercise.

Monica Davalos shops with her father, Ernesto Davalos, 72, in Tukwila. For years, Davalos’ family didn’t pay attention to her advice about nutrition and health — things she learned through Global to Local. It wasn’t until her father’s diabetes diagnosis and hospitalization in January that he started to become interested in fruits and vegetables.

Maria Phillips and her daughter, Jazlyn Gaytan, greet Davalos at Foster High School for their weekly walking group. Davalos works as a Latino community liaison with Global to Local in Tukwila and SeaTac. She helps organize child care so mothers can attend exercise classes and cooking groups.

WHEN MONICA Davalos came to Tukwila from Mexico nine years ago, she was excited for the opportunities that awaited her husband and two young children. She was eager to become part of a growing community where 30 percent of her neighbors are foreign-born — where signs for Jack in the Box and airport hotels mix with ones for Mexican grocery stores, Indian restaurants, Ethiopian beauty salons, Halal butcheries and down-at-the-mouth little diners.

It never occurred to her that coming to this new place might increase the chances she’d get sick. But that is exactly what happened. She gained weight, developed high cholesterol.

Davalos explains how it happens: In Mexico, “it’s not so easy to have a car, so we walk everywhere.” There, people eat fresh fruits and vegetables because they’re cheap and easy to get. Here, “we have to go everywhere in a car.” Her husband spends hours driving to different roofing jobs. With four kids now, the couple is shuttling them to three different schools, including one with a special program for a son who is deaf. And the places to eat? Mostly they’re fast-food restaurants and 7-Elevens that brim with Doritos and Twix bars. Shoppers are lucky to unearth a mealy apple.

It turns out that Monica Davalos’ story is one shared by all too many people in South King County.

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Maps of how people die in King County tell a stark story of inequity. Life expectancy varies by as much as 12 years across the county. In the Tukwila/SeaTac area, the teen-pregnancy rate is almost three times as high as it is in the rest of the county; twice as many students are on free and reduced-price lunches; and people are 1½ times more likely to die of diabetes-related causes. Perhaps most shocking, 17 percent of kindergartners in Tukwila are homeless.

Davalos knew about many of the circumstances in her neighborhood that led to these things, but she had no idea what to do about it. Then, a friend invited her to a community gathering that would change the direction of her life.

ON ANYBODY’S roster of major players in the high-stakes game of global health, the Seattle area likely makes the cut. When the Washington Global Health Alliance of research and service organizations mapped Seattle’s reach, it found more than 2,503 projects in 156 countries working on everything from preventing AIDS and fighting malaria to digging wells and installing latrines.

Ironically, “there’s less awareness, and there is far less motivation to do things locally,” even though the problems are dire and the need is great, says David Fleming, director of Public Health-Seattle & King County.

In an attempt to right this deep irony, Fleming’s department has joined forces with the global-health alliance (http://www.wghalliance.org/), HealthPoint (a nonprofit network of health clinics) and Swedish Health Services
to bring the strategies that have worked halfway around the world back home to Seattle’s own underserved communities. The collaboration, called Global to Local, is focusing on chronic diseases — especially diabetes and heart disease — that are the biggest health problems facing Americans and increasingly the world. But the goal is to do more than treat disease. This effort, now in its fourth year, seeks to root out the causes and make changes that will keep people from getting sick in the first place.

Global to Local teamed up with SeaTac and Tukwila because, while the two communities face plenty of challenges, they also have city governments and a solid base of locals already committed and involved.

Eager as this new coalition was to jump in, its leaders are painfully aware that when well-intentioned outsiders show up to fix things, it doesn’t always go well. Mosquito nets have ended up being used for fishing instead of malaria prevention; donated medical equipment has been stolen and sold by profiteers. So from the start, the group dug into the grass roots to get the lay of the land. Adam Taylor, Global to Local’s program director, explains:

“We want to make sure that people get medical care when they need it. But the conditions that lead to poor health in the first place aren’t things that doctors are addressing, they’re things that are addressed in the community, and that’s what we’re trying to do.”

So the new group’s first big move was to host “Community Conversations” in local churches and other gathering places to ask folks what their problems were and what might help. The stories were often the same: No money for health insurance. Good grocery stores and nonprofit clinics too far away for the many without cars or money for regular bus rides. And even for those who could afford them, buses were limited. Walking is difficult where the main thoroughfare, International Boulevard, is a heavily trafficked, four-lane road with few sidewalks, nearby parks or green spaces. People felt isolated, afraid to walk or let their kids play on busy, sometimes dangerous streets. Many, like Davalos, said they simply didn’t know what to do or where to turn.

Global to Local got the message: Complement the services already in place. Help connect the dots.

MONICA DAVALOS connected with Global to Local at one of those community meetings her friend had invited her to. She found people who shared her concerns, understood the challenges. And a world of opportunities opened up: nutrition and exercise classes, help getting to clinics, people to talk to.

Encouraged by a Global to Local-sponsored “community health promoter,” she became the Latino community liaison for the program. Though shy about her English, she confesses, “I like to talk; I talk a lot.” And that she does, easing fears, offering encouragement and helping folks sign up for diabetes workshops, yoga, nutrition classes. Soon she started leading a walking group, too.

“People talk to me, and they tell me, ‘I am sick, I have problems with my cholesterol’ or ‘I am diabetic’ or ‘I would like to do more exercise but I can’t do it by myself,’ ” Davalos says.

That’s where the caring community groups come in. With a congregation of about 100 people, Riverton Park United Methodist Church has opened its arms wide to those in need. It’s where Davalos brings many of the people she connects with. In its big, light social hall next to the sanctuary, free meals are served every Tuesday night. Tables and chairs are folded and set aside so there’s room for exercise classes. Davalos arranges for child care while the moms work out. The church also sponsors health screenings and runs a food bank in the basement.

But the church hosts more than programs. It hosts families, too.

Tony Tansey first came to the church because he and his 3-year-old daughter, Kylie, were homeless. A cabinetmaker who has steady work, Tansey still struggled on one income to afford day care. He fell into debt. After living in motels for several months, he came to the church to see if he could stay long enough to get caught up and even a little ahead.

The Rev. Jan Bolerjack says the church almost always has families staying with them, sometimes as many as three or four. But far more people come asking for help with other challenges, whether it’s what to eat, how to find a doctor or where to get training for a job. Global to Local, she says, has been able to reach into immigrant and refugee populations, connecting them to an array of services while encouraging them to make their own changes. In one important area — diet — she’s seeing the changes.

“This community lives on potato chips. It’s the cheapest food,” she says. But through the classes and the health outreach workers, “families learned you can’t live on potato chips and soda. We’ve seen ethnic markets open up so they can eat native foods, and they are much healthier.”

But even with the changes, having access to healthful food remains an issue for many. Alma, who fled an abusive relationship in Mexico when she was 16, is married now with two children. They struggle to get by on the odd jobs her undocumented husband gets. Alma struggles, too, with her weight and high blood pressure. She relies on the limited choices at the food bank to feed her family: “You have to eat whatever you have available.”

But she has found a lot of help dealing with her health issues. Uninsured, she was connected to the New Hope Health Center, another one of the community partnerships that Global to Local formed through Pastor David Sobocinski to get care to people like Alma. Based in his Fellowship Bible Church, the center offers a variety of services, including free clinics and counseling. It also hosts a Medical Teams International dental-care van, partly financed by Global to Local, to serve people who have no insurance or can’t cover all the bills.

Alma Villegas, Global to Local’s community programs manager, says the services already in place “laid a lot of the groundwork for us to be able to come in.”

Among the other critical connectors is HealthPoint, the network of 17 clinics operating in King County. Rita Rai, a 16-year-old whose family fled persecution in Bhutan, says they are grateful for the chance to make a new life in Tukwila. The government burned their house in Bhutan, forcing them into a refugee camp in nearby Nepal. But it’s not been altogether easy here. Her father, Suk, started having seizures a few months ago and, without a car, it took them two bus rides to get him to an emergency room. Doctors discovered he has a rare form of diabetes. He hasn’t been able to work since. Fortunately, he’s found medical services through HealthPoint.

“I do not know what happened to my health,” Suk says. But he wonders if part of it is the food, with its high fat, sodium and sugar. Rita wonders, too, noting that she’s put on 15 pounds since coming to America.

Even so, Suk says, he’s glad they made the journey. “My children, they have the opportunity to go to school . . . I’m so excited to be here.”

ALL AROUND the south county, Global to Local continues to connect the dots. Latino, Somali, East African and Burmese health promoters, modeled on those that global-health groups used successfully, are in the field, easing communication. Global to Local set up a connection desk, staffed by University of Washington and Seattle University students, linking people to interpreters, language classes and computer training, and helping folks with everything from paying utility bills to signing up for health insurance. Carpools have been organized; bus vouchers delivered. The cooking and exercise classes are gaining traction.

Not everything is solved, of course. Poverty abides. Streets remain dangerous. Many still lack steady jobs and insurance. Possible cuts to bus service threaten to make transportation even more difficult.

But for people like Davalos, even the start of this work signals a huge departure from the past. She’s lost at least 12 pounds and expects to lose more. Her husband, who was reluctant at first and resentful of all the changes Global to Local seemed to impose on their home (and refrigerator), now agrees to eat the healthy food she makes. He and the kids join her when they can in the walking group.

And after her dad, visiting from Chicago, ended up in the emergency room this past January and found out he had diabetes, the family came together and grew even more committed to turning things around.

Her dad “never learned or knew what I know now because of Global to Local,” Davalos says one day at Global to Local’s offices in SeaTac, where many cooking and exercise classes are hosted. “All of this, it’s an opportunity to change our life.”

In the next room, 20 Somali women are taking a cooking class for mothers of infants transitioning to solid foods. A new generation, getting a good start.

Abigail Higgins is a freelance journalist working primarily in Kenya. Erika Schultz, a Seattle Times staff photographer, contributed to the reporting of this story.